UPPER CROSSED SYNDROMEWHAT IS IT, WHAT CAUSES IT, WHAT DOES IT LOOKLIKE, AND HOW TO EFFECTIVELY ADDRESS IT

YESTERDAY I talked about Dr. Janda's Lower Crossed Syndrome. Today we tackle the upper body's analogous muscle imbalance pattern; Upper Crossed Syndrome. Like its counterpart, this biomechanically aberrant pattern has a great deal to do with FORWARD HEAD POSTURE --- truthfully even more so. Without any further adieu, let's start answering the questions posed by the title one at a time.

As seen by the pictures above, Upper Crossed Syndrome is where the chest muscles (pectorals) and rear neck muscles (upper traps, LEVATOR SCAPULAE, suboccipitals, and SCM, which in this context is considered a rear or at least a lateral neck muscle) are overly tight, while the upper back muscles (rhomboids, lower trapezius) and front neck muscles (PLATYSMA, SCALENES) are weak (or at least inhibited in their firing). According to Janda's book Assessment and Treatment of Muscle Imbalance: The Janda Approach (as paraphrased by the group officially carrying on his work --- The Janda Group at Muscle Imbalances dot com), Upper Crossed Syndrome leads to.....

"Dysfunction, particularly at the atlanto-occipital joint, C4-C5 segment, cervicothoracic joint, glenohumeral joint, and T4-T5 segment. Postural changes decrease glenohumeral stability as the glenoid fossa becomes more vertical due to serratus anterior weakness leading to abduction, rotation, and winging of the scapulae. This loss of stability requires the levator scapula and upper trapezius to increase activation to maintain glenohumeral centration (Janda 1988)."

Follow along as I show you why this is bad stuff, as well as how to start dealing with it on your own.

WHAT DOES UPPER CROSSED SYNDROME LOOK LIKE?

Like Upper Crossed Syndrome, the causes are many and varied, with many being similar. Much of this centers around the fact that POOR POSTURE is contagious. No; I don't mean that you'll spread it to your buddy like some kind of crazy disease. I mean that once you start having certain characteristics of poor posture in one area, it progresses to others. Things can slide downhill quickly as as thanks to compensation, the whole mess progresses (see link on FHP at the top of the page). Loss of normal spinal alignment causes loss of normal joint motion or movement patterns, which in turn leads to PHYSICAL DEGENERATION in the form of loss of joint space, calcium deposits in soft tissues, and bone spurs (osteophytes). There are other signs of Upper Crossed Syndrome.

HUMPBACK: This, folks, is a no-brainer. If you have overly tight chest muscles pulling you forward and weak upper back muscles failing to resist their pull, you will be pulled forward. In other words, you'll eventually end up battling FHP's evil twin, "Hunchback" (I often times refer to this as "THE POSTURE OF AGE"). Sometimes these folks will actually have a normal-appearing (or even hyperlordotic neck) from holding their head up as the whole mess slides anteriorly (forward). After looking at thousands upon thousands of X-rays of the neck in profile (lateral cervical spine), over the course of twenty five years, all I can say is that cervical lordosis is rare. What's common is that humpback and FHP are seen together, pulling people further and further forward, self-perpetuating the problem.

VARIOUS KINDS OF SCAPULAR ABNORMALITIES: When you see winged scapulas or abnormal scapular positions of almost any kind, start to suspect Upper Crossed Syndrome.

CHRONIC PAIN: Remember what I showed you several months ago (HERE) --- that postural abnormalities over time are one of the many ways to create SCAR TISSUE / FASCIAL ADHESIONS / FIBROSIS / DENSIFCATION, or whatever else you choose to call it? Upper Crossed Syndrome also happens to be one of the prime factors in developing TRIGGER POINTS in the area of the upper back, pec minor, SCM, and levator --- none are worse than the levator (see earlier link on the levator). Add Scar Tissue with Trigger Points and you have the "Myofascial Syndrome". Thus, it is common to see people with Upper Crossed Syndrome dealing with HEADACHES, CHRONIC NECK PAIN, and various forms of RADICULOPATHY, including THORACIC OUTLET SYNDROME.

WHAT CAUSES UPPER CROSSED SYNDROME?

Honestly, this is largely the same group of actors we saw with Lower Crossed Syndrome. However, there are specifics here that need to be addressed.

SITTING COMBINED WITH POOR POSTURE: Sitting itself is bad enough, but combine it with a slumped posture, and you are setting the table for future problems. In our age of computers, sedentary lifestyles, texting, etc, etc, this problem continues to grow.

ABERRANT TRAINING PATTERNS AND REPETITIVE SPORTS: Unfortunately, I find that when it comes to physical training and activity, way too many people are doing things wrong. Often times darn drastically wrong. Allow me to give you a prime example. I never used to see serious shoulder problems in high school volleyballers. Now they're common. Young teens (and even adolescents) serving and spiking who-knows-how-many-times, at least five, often six, and sometimes seven times a week. With the advent of longer seasons, summertime "open gym" sessions, and JO's (Junior Olympics), these girls are going through what amounts to a pitching motion, hundreds upon hundreds of times a week. This is interesting in light of the fact that big league pitchers are on a five-day rotation, usually with a pitch-count limit of 100 or so, and after pitching, have the arm encased in ice and do all sorts of therapy until they pitch again.

LARGE BUSTS: Large breasts have a tendency to pull women into a slumped or rounded-shoulder posture. My experience is that there comes a point where reduction may be necessary to achieve any sort of lasting relief. I can say that of my patients who have gone through reductions, I have yet to see one who regrets it.

EFFECTIVELY DEALING WITH UPPER CROSSED SYNDROME

Although lifting weights can be an integral part of solving Upper Crossed Syndrome, frequently it's weightlifting that causes this problem (or at least heavily promotes it) in the first place. For instance, people love to work the muscles they can readily see in a mirror --- chest, biceps, abs (almost always in the form of SITUPS), front shoulders, and quads, while ignoring (or at least minimizing) muscles they can't see (upper back, lower back, glutes, and hamstrings).

What this tends to do --- especially in the upper body --- is cause a head-forward, shoulders-rounded, bent-forward, slumped sort of posture. This is why when it comes to dealing with Upper Crossed Syndrome, I'm a fan of focusing on posterior chain muscles, while limiting presses (benches / military) and doing a lot of EXTENSION TYPE WORK; as much on a ball as possible. Just remember, however, that exercises are not necessarily the best starting point. When it comes to solving this problem.......

STUDY AND CREATE A WRITTEN PLAN --- AN EXIT STRATEGY IF YOU WILL: There are so many articles and YouTube videos on the subject that while you may not be an "expert" with just a few hours of study, you'll start seeing the bigger picture. EXIT STRATEGIES work, and like they say --- failure to plan is planning to fail.

DEAL WITH UNDERLYING SCAR TISSUE AND SUBLUXATION: Contrary to what most practitioners (PT or DC) say, this does not mean starting with lots of exercises (HERE) or adjustments (HERE) respectively. What it does mean is that you may need to deal with the effects of Scar Tissue (see earlier links) if it is present. Why is this important? Scar Tissue has a TETHERING effect that limits normal ranges of motion. Loss of motion, or abnormal motion patterns sooner or later lead to pain. But unfortunately, pain is not where this little shindig ends. The end product of Upper Crossed Syndrome is always the degeneration I spoke of earlier.

TREAT THE PROBLEM AS THOUGH IT WERE SYSTEMIC: Look; I'm not going to tell you that changing your diet, giving up the SMOKES, taking care of your GUT, and starting an exercise program are automatically going to "cure" your Upper Crossed Syndrome. However, if you can effectively and naturally deal with INFLAMMATION --- particularly SYSTEMIC INFLAMMATION --- you are better off. This is a cold, hard fact that is always true 100% of the time.

STRETCHES AND EXERCISES: I'm not going to give you tons and tons of specifics here as there are many other sites that have done a far better job than I. I will, however, give you some tidbits to chew on. For starters, before starting, make sure you understand LOWER CROSSED SYNDROME and it's relationship to CORE STRENGTH. I also suggest you learn to do what I call the Chicken Head Move. Huh?

CHICKEN HEAD MOVE (CHIN TUCK) WITH SCAPULAR RETRACTION: Growing up on a Kansas farm, I've seen plenty of chickens bobbing their heads back and forth as they move. When you do a Chin Tuck, tip your chin slightly downward (I did say slightly). Now take your chin in your hand and move it forwards and backwards CHICKEN HEAD STYLE. Ultimately, what you want to do here is be able to control the muscles that allow you to tuck your chin back as far as you can get it. Then retract your scapulas --- pull your shoulder blades back towards each other. Practice this and make it your go-to posture for dealing with Upper Crossed.

OTHERS: Frankly, there are so many cool exercises and stretches for Upper Crossed Syndrome that I could write a book. Again, search the web. In the meantime, I included a little slide show of some of the exercises and stretches that might be of benefit (yes, I realize that some of these will need to be modified for the average person). And because there is so much overlap, make sure to at least look at the exercises and stretches used for people with Lower Crossed Syndrome.

POOR POSTURE AND THE RELATIONSHIP TO CHRONIC TRIGGER POINTSCOMBATING THE POSTURE OF AGE

According to Webster's 1913 Dictionary, the word combat means, "To struggle or contend, as with an opposing force; to fight with; to oppose by force, argument, etc; to resist;a contest of violence; a struggle for supremacy". When you see how many seemingly unrelated health problems other than CHRONIC PAIN are being related to too much sitting and poor posture, you'll realize that "combat" is not too strong a word to use when talking about the battle between gravity and our spines / bodies.

I talk about it all day long to my patients. How best to deal with (or "resist") the posture of age. What is the posture of age you ask? It is simply having a stooped back and shoulders, with a chin that tends to find its resting point too close to the chest ---- something that in younger folks we refer to as "Poor Posture". Unfortunately, in older folks it's another one of those things that's considered normal. Common, yes. Normal; not on your life.

I have told you previously that POSTURE IS IMPORTANT. I've also discussed the necessity of having a lordotic curve (proper forward curve) in your neck (HERE, HERE, and HERE) --- something that few people have, and that fewer doctors / radiologists recognize as abnormal. While I am a huge fan of the DAKOTA TRACTIONDEVICE, there is a simple ball exercise --- a stretch really --- that can help both the REVERSE CERVICAL CURVE as well as the posture of age.

It's this simple; if most people spend way too much time in the posture of age, we have to figure out a way for them to spend a bit of time counteracting or combating it. While INVERSION is great for any number of spinal issues, it's not going to do much for this particular problem. In order to work against this posture of age, you'll need an Exercise Ball.

Make sure your EXERCISE BALL is "height appropriate". When you sit on it, your knees should be at approximately 90 degrees.

While sitting on the ball, simply roll your butt down toward the ground and lean backwards until you are lying on the ball.

Let your head go backwards into it's natural lordotic curve. Make sure to put your arms out like a crucifix or over your head like you would do if a train robber put his six gun in your belly (remember though --- you are lying on your back right now). This way you are stretching all the muscles of your anterior (front) neck, as well as your anterior shoulders, biceps, and chest muscles.

Now; just stretch. Don't do any SIT UPS OR CRUNCHES. Don't do any Reverse Planks. Just lay there and feel everything stretch (feel free to move roll around a bit on the ball while you are stretching). While there's not set time limit, try and do at least a minute (for those of you just starting out, you may need to do considerably less until you get used to it). Two or three minutes or more would be better. This is the kind of thing that is going to help you much more before the pain is raging (or better yet, before you even have pain); not just when those UPPER TRAPEZIUS TRIGGER POINTS are fired up and you are hurting.

If you have a job that entails lots of driving, sitting at a desk, hunched over a computer, or any number of other jobs, you may want to consider this simple routine. Also, if you are a person who likes to sew, knit, read (especially in bed with your head propped up), or have spent years doing too many situps, crunches, bench presses, pushups, arm curls, or exercises that build the front side of the upper body, while neglecting the back (hyper-extensions, the Roman Chair, etc, etc, etc) you'll need to do these as well.

CHRONIC PAIN AND OTHER HEALTH PROBLEMS ASSOCIATED WITH FHPFORWARD HEAD POSTURE

EXAMPLES OF LOSS OF CERVICAL LORDOSIS OR REVERSE CURVE (KYPHOSIS)

Image by Hellerhoff

Image by Lucien Monfils

Image by Hellerfoff

"Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture (FHP) may result in the loss of 30% of vital lung capacity. These breath-related effects are primarily due to the loss of the cervical lordosis...”Dr. Rene Cailliet (M.D.), former director of the Department of Physical Medicine & Rehabilitation at USC.

EXAMPLES OF A LORDOTIC CERVICAL CURVE

The group of people whom I would have to say is the most knowledgeable about neck curves, what constitutes a good curve, what constitutes a bad curve, and how to change (improve) a poor curve, are the CBP Practitioners. CBP (Chiropractic Biophysics) was invented by Chiropractor and Mathematician, Dr. Don Harrison. According to former CBP instructor and expert in restoration of the normal cervical curve, Dr. Mark Payne, "normal" is somewhere between 25 to 35 degrees (as measured by Jackson's Angle). This curve acts in similar fashion to an axle spring. The spring dissipates force, taking pressure off the spinal discs.

On the other hand, if you do not have the proper amount of curve (or you have a reverse cervical curve), force is not only not dissipated, it is redistributed in a manner that both causes and accelerates the degenerative processes which are at work on all of us due to the effects of gravity. Instead of acting like a spring, your neck can end up pounding your discs like a hammer pounds a nail. As you might imagine, the resulting mechanical dysfunction causes a host of problems which can actually be seen on X-ray. The first of these is something called "Sclerosis" (a build-up of calcium). When this gets more severe, there will be bone spurs that form. Right along with these is DISC DEGENERATION. The bottom line is that anything that keeps your spine from moving like it should move (including having the proper curvature and GOOD POSTURE) will cause or accelerate Spinal Decay.

RESULTS OF HAVING AN IMPROPER CERVICAL CURVE

If you look at the peer-reviewed literature on the subject, there is a great deal of information concerning the proper cervical curve as well as problems associated with the loss of the normal lordosis. I will warn you up front that this is not information that you will hear from your doctor. Although your doctor will never mention it (sometimes the radiology report will say something along the lines of "loss of normal cervical lordosis"), loss of this curve is a bigger deal than most people ---- including chiropractors ----- realize. These problems include what I refer to as "The Big Three"

WHAT IT TAKES TO ADDRESS IMPROPER CERVICAL CURVES

After 25 years in Chiropractic, I can assure you that no matter how beneficial CHIROPRACTIC ADJUSTMENTS can be (and they can be very beneficial), they are not, all by themselves, going to significantly improve the lordotic curve of the cervical spine. In fact, in many cases, NUMEROUS ADJUSTMENTS do not even begin take care of the pain, let alone change the cervical curve. So; besides the adjustments, you are going to have to do some tractioning (HERE). Think about it; traction is what the braces that my two oldest children are wearing, do to their teeth in order to straighten them (yeah; I have two kids in braces right now).

The great thing is; once your chiropractor has put you through the proper tests and figured out that you can tolerate Cervical Extension Traction, you can do most of it at home with inexpensive devices such as my favorite, the DAKOTA TRACTION UNIT (thanks Dr. Tressler!). Not only does it have the ability to help the problems listed above by improving the biomechanical function of the cervical spine, it is my belief that Cervical Extension Traction (along with EXTENSION EXERCISES) are probably the single best methods of dealing with the CHRONIC TRIGGER POINTS that do not respond to SCAR TISSUE REMODELING.

POOR POSTURE AND THE RELATIONSHIP TO CHRONIC NECK PAIN

Alehandra13 - Polska - Pixabay

“Headaches and tension in the shoulders and back are often created by chronic bad posture. If you’re slouching, you may also have gastrointestinal reflux or feel fatigued because you’re unable to breathe deeply.” Spokesperson for the American Physical Therapy Association (APTA); New York City Physical Therapist, Peggy W. Brill

Can CHRONIC NECK PAIN be related to posture? You bet your sweet bippy it can! If you are one of those people who struggles daily with Chronic Neck Pain, I hope that you have read my post on the PROPER CURVATURE of the cervical spine (neck). In it, I speak extensively about the relationship of c-spine posture to neck pain (there are actually A LOT OF STUDIES in this area). In fact, I would go as far to say that a slumped / head-forward, shoulder-forward posture is one of the biggest culprits in those struggling with Chronic Neck Pain.

Your body is designed for good posture. What I mean by this is that your spine is specifically designed with a number of curves in it (see animation). No; these are not the side-to-side curves that are known as 'Scoliosis'. These are the curves that can be seen from front-to-back when looking at people in profile. Your neck and low back should have what are known as lordotic curves (lordosis), while your mid back and sacral areas should have an opposite curve --- a kyphotic curve (kyphosis). All too often and for a whole host of reasons, this is not the case. Note that in the animated skeleton to the left, the neck actually has a degree of FHP or "FORWARD HEAD POSTURE".

When you have poor posture, it puts enormous amounts of abnormal mechanical stress on your joints, including your MUSCLES, TENDONS, and FASCIA. Not only can this lead to JOINT DECAY & DEGENERATION over time, it can lead to a whole host of other problems as well. In fact, once you understand the concept of SUBLUXATION, it is not difficult to see that poor posture could potentially cause any number of physical ailments. And whether the SCAR TISSUE came first, or the poor posture came first; either one can cause the other over time, leading to a vicious cycle of pain and DJD (Degenerative Joint Disease).

Despite the fact that medical radiology reports will usually mention loss of normal lordotic curve in the c-spine if it is present (more often than not, it is), your doctor will never mention this to you as a potential source of your neck pain (NECK PAIN, RADICULOPATHY, HEADACHES, etc). About the best you can hope for is to be given a few stretches to help loosen things up a bit. At worst (this is more typically the case), you'll be prescribed PAIN KILLERS, NSAIDS, MUSCLE RELAXERS, and CORTICOSTEROID INJECTIONS --- and when those don't work, ANTIDEPRESSANTS. My goal with this post is to help keep you off of drugs and out of the surgeon's office. In other words, I want you to leave my clinic with an EXIT STRATEGY in hand.

A FEW COMMON CAUSES OF POOR POSTURE

BORN THAT WAY: Although this is used as an excuse far too often, there is some degree of truth to it. All you have to do is look at family pics to figure this out. However, whatever sort of spine / posture you were born with; there are things you can do to improve and maintain it. EPIGENETICS rule over genetics.

PAIN: I hear it all the time; "If I sit up straight, I hurt worse. Slouching and slumping helps relieve some of the pain in my neck and between my shoulders". If this is in fact true, it merely means you have to deal with the underlying cause(s) of your pain. See next bullet point.

OLD INJURIES: I cannot tell you how many people I see on a day-to-day basis whose pain started with some sort of injury. One of the most common is WHIPLASH (whether caused by a CAR WRECK, ABUSE, or something else). Another is SPORTS INJURIES. Muscle Guarding / Splinting and SCAR TISSUE(often referred to by the medical community as "FIBROSIS") are commonly found together after these sorts of injuries --- often years or even decades after the fact. Injuries also tend to lead to muscle imbalances, which work in tandem to create poor posture. The poor posture causes further muscle imbalances, which can lead to more Scar Tissue, Fibrosis, and Adhesion. Repeat. The end result is always degeneration of all affected tissues (HERE). If you want to see a real-life example of this phenomenon in action, HERE it is.

BAD HABIT(S): When I was in school, if you slumped or slouched, a teacher was going to say something to you (I had a shop teacher who would actually throw a chalk eraser at you if you slumped in your chair). Now it seems like the worse you can slouch, the cooler you are --- sort of like wearing pants so low that half your boxers show. Thus, poor posture causes more of the same. Your body will eventually recalibrate its PROPRIOCEPTION / MECHANORECEPTION so that slouching seems normal. Trust me; good posture does not get easier as you get older.

STRESS: How many people do you know who are under serious stress that are able to maintain great posture? Not many. Stress tends to fold you up into a ball (HERE). I realize it's far too easy for me to simply tell you to de-stress your life. But truthfully; figure out what it will take to have less stress in your life and do it.

AGE: As we age, we tend to slump forward (HERE). Simple as that. Read the next bullet point to understand this phenomenon better.

POOR NUTRITION / OSTEOPOROSIS: Despite what you have been told, there are some things that you can do to help your cause when it comes to OSTEOPOROSIS. As an osteoporotic spine is pulled forward, the fronts of the vertebrae start to 'compress' into a wedge shape. This pulls the body forward even more. Can you see a viscous cycle forming? Click on the link above to learn how to defeat Osteoporosis.

POOR FOOT MECHANICS / POOR FOOTWEAR:Unfortunately, I learned about this one firsthand. If you constantly wear flip flops or crappy shoes; or if you have poor biomechanics of the feet, it can cause postural abnormalities that can literally affect your entire body ---- including your neck.

GOOD NUTRITION / PROPER HYDRATION: It stands to reason that if poor posture can, at the very least, be related to poor nutrition, it might be beneficial to work on that area. I have written about this extensively. HEREis where you can start to learn about real nutrition. And seriously; if you are one of those people who struggles with Chronic Neck Pain and are drinking anything other than good old H20 --- shame on you! INFLAMMATION is at the root of nearly every problem imaginable, including neck pain. It is not a reach to come up with a couple dozen ways that increased levels of Inflammation could affect your posture (much of it revolving around the fact that OVERWEIGHT / OBESITY are both considered to be "inflammatory".

EXERCISE / STRETCH / CORE STRENGTH: While it is not universally true, for the most part, if you are doing these three things, your posture will be better than those who are not ---- usually much better.HERE, HERE, and HEREare some links to get you started in this area. You will have to spend some time studying this one on your own.

FOCUS: In order to create good posture, you are going to have to think about what you do, as well as pay attention to the way that you sit and stand. Whether sitting or standing, use a mirror (or better yet, have someone take a picture of you when you least expect it) to monitor your progress.

PROPER ERGONOMICS: I once had a UPS driver who would not get better. He would do OK for a few days and then start hurting in his upper back again. I could not figure it out until he showed me his truck. As crazy as it sounds, the seat was off-set from the steering column by nearly a foot. They gave him a different truck; problem solved. A couple things I will mention here is using an Exercise Ball as a work chair, as well as using a 'Stand Up Desk'. After reading the article, "Sitting is the New Smoking," I am going to start standing much more.

Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).